title: Higher comorbidity rates in unemployed patients may significantly impact the cost of spine surgery.
abstract: Chronic back pain is commonly associated with physical and mental comorbidities, which create a considerable burden on the healthcare system. We examined the differences in comorbidity rates of 619 spinal surgery patients of employment age, and the impact of comorbidity rates on length of hospital stay and cost. The charts of patients aged >25 years and <65 years were reviewed retrospectively. Type of surgery, employment status, comorbidities, length of stay and hospital charges were studied using chi-square, Fisher, Student's t-test, Wilcoxon-Mann-Whitney test and multivariate analysis. The unemployment rate among employment-aged spinal surgery patients was 44.7%. Unemployed patients who underwent any of the three types of surgery (anterior cervical decompression and fusion, lumbar decompression and fusion, and lumbar microdiscectomy [LMD]) stayed longer in hospital but had higher hospital charges in the minimally invasive LMD group only. There were higher rates of some comorbidities in unemployed compared to employed patients: asthma (12.2% vs. 5.9%), coronary artery disease (20.4% vs. 12.8%), diabetes mellitus (58.0% vs. 47.3%), history of coronary artery bypass surgery or stent placement (18.2% vs. 11.6%), hypothyroidism (14.4% vs. 8.2%), knee joint disease (43.1% vs. 33.6%), chronic renal disease (12.9% vs. 2.9%) and opioid (55.2% vs. 45.9%) antidepressant (37.0% vs. 25.3%) anxiolytic (16.0% vs. 8.9%) use. Charlson comorbidity scores were significantly different (p<0.001) between unemployed (1.72 ± 1.90) and employed patients (1.03 ± 1.55). Multivariate analysis showed that a history of coronary artery bypass/stent procedure, chronic renal disease or preoperative opioid use had a significant impact on length of stay and hospital charges in unemployed spine surgery patients. Thus, unemployment in spinal surgery candidates is associated with higher comorbidity rates with a significant impact on healthcare cost. More research is needed into the relationship between unemployment and consumption of healthcare resources.
authors.affiliation: Medical Center of Central Georgia, 840 Pine Street, Suite 950, Macon, Georgia 31201, USA. mswalid@yahoo.com
authors.forename: Mohammad Sami
authors.initials: MS
authors.lastname: Walid
authors.forename: Edward C M
authors.initials: EC
authors.lastname: Robinson
authors.forename: Joe Sam
authors.initials: JS
authors.lastname: Robinson
mesh_terms: D000328:Adult; D001416:Back Pain / Q000150:complications / Q000191:economics*; D002318:Cardiovascular Diseases / Q000150:complications / Q000191:economics; D003920:Diabetes Mellitus / Q000191:economics; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications / Q000191:economics; D019637:Orthopedic Procedures / Q000191:economics* / Q000706:statistics & numerical data; D013131:Spine / Q000601:surgery*; D018709:Statistics, Nonparametric; D014478:Unemployment